Chronic obstructive pulmonary disease (COPD) is a disease encompassing chronic bronchitis and emphysema that generally affects smokers and older patients. Current treatment of COPD is dominated by bronchodilators that help alleviate the symptoms. All COPD patients should use a short-acting bronchodilator, a beta2 agonist, a muscarinic antagonist, or a combination of the two to control acute exacerbations of the disease. In addition, many patients receive a long-acting bronchodilator (e.g., long-acting muscarinic antagonist [LAMA], long-acting beta2 agonist [LABA]), often accompanied by an anti-inflammatory agent (e.g., an inhaled corticosteroid [ICS]). In this report, we use national patient-level claims data to explore the position of the leading bronchodilator and anti-inflammatory therapies in the treatment of newly diagnosed COPD patients; we provide a quantitative analysis of treatment patterns and share by line of therapy, as well as progression between lines, duration of treatment on each line, and use of concomitant treatment. We also quantify, among recently treated patients, a drug’s source of business compared with its competitors and detail which drugs precede others through an analysis of add-versus-switch patterns. Additional analyses explore persistency and compliance by brand.

Questions Answered in This Report:

  • Newly diagnosed patients: Within the first year of diagnosis, only 42% of newly diagnosed COPD patients progress to a first-line therapy. What percentage of these patients progress to a second- or third-line drug within the first year? Which products capture the most patient share in the first, second, and third lines of treatment? How do short-acting bronchodilators fare against long-acting maintenance therapies?

  • Recently treated patients: Spiriva (Boehringer Ingelheim/Pfizer) and Advair (GlaxoSmithKline) continue to be the most widely prescribed treatments for recently treated COPD. Which agents and drug classes have experienced increased or decreased use over the last four quarters under study? How and when do patients progress from one therapy to the next in COPD, and how does this progression differ between key drugs? Are most recently treated patients with each key brand coming through new (adds/switches) or continuing business?

  • Pathways to key therapies: Longitudinal claims data reveal that use of Spiriva in COPD is greater than that of individual LABA/ICS combinations, although the LABA/ICS class as a whole is prescribed more often than LAMAs. From which specific therapies do patients receiving Spiriva and LABA/ICS combinations originate? When Spiriva and the LABA/ICS combinations are used as part of a combination regimen, with which drugs are they taken? How do these maintenance therapies compete with short-acting therapies for first-, second-, and third-line space?

Scope:

Primary patient-level data: Quantitative findings from our analysis of data covering approximately 40 million lives providing the most representative sample of U.S. treatment practice for Medicare and commercially insured patients. This report is delivered as a key findings slide deck and a dashboard that can be accessed using the Internet with claims that are between 6-12 months old at time of publication.

Patient Sample: Patients who are continuously enrolled for the complete two-year study period must meet the following condition: at least two claims with a diagnosis code for COPD (International Classification of Diseases, Ninth Revision [ICD-9] diagnostic codes 491.20, 491.21, 491.22, 491.9, 492.8, and 496) during the study period. Patients must be at least 40 years or older.

Quantified lines of therapy analysis showing exact share of each agent in each line of therapy, including rate of progression between lines and length of time patients are on each line.

Newly Diagnosed Patients:

- Patient share by drug class and key products across three lines of therapy, within one year of diagnosis.

- Patient flowchart through one year of treatment for all first-line products, including progression rates and add/switch behavior.

- Polypharmacy and key concomitant therapies by line of therapy.

- Quarterly trending of patient share by line of therapy.

Recently Treated Patients:

- Quarterly snapshot of patient share by drug class and key products.

- Pathway to key therapy flowcharts tracking the preceding therapy patterns for all key therapies, including add/switch behavior.

- Brand source of business, including share for continuing, new (switches/adds), and new (initial therapy) business.

- Polypharmacy and key concomitant therapies.

- Drug persistence and compliance.

- Quarterly trends in patient share for all key therapies.


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